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DIT Endocrine > End 2 - Pituitary > Flashcards

End 2 - Pituitary Flashcards

1
Q

From where does the anterior lobe of the pituitary develop?

A

Forms from Rathke’s pouch (ectodermal diverticulum).

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2
Q

From where does the posterior lobe develop?

A

Form from invagination of the hypothalamus (neuroectoderm).

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3
Q

What does ADH do?

A

Decreased urine output. Vascular smooth muscle constriction.

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4
Q

What are 2 stimulators of ADH?

A

Nicotine and Opiates.

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5
Q

What are 3 inhibitors of ADH?

A

Ethanol. Atrial natriuretic factor. Decreased osmolarity.

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6
Q

What does Oxytocin do?

A

Milk ejection (breast). Uterine contraction.

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7
Q

What does FSH do? What is the upstream regulatory hormone?

A

In women, FSH causes follicular development. In men, acts on Sertoli cells to mature sperm (spermatogenesis). The upstream regulatory hormone is Gonadotropin releasing hormone (GnRH), and must be pulsatile.

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8
Q

What does LH do? What is the upstream regulatory hormone?

A

In men, it causes testosterone production by stimulating Leydig cells. In women it acts on theca-lutean cells to help produce estrogen and progesterone production. The upstream regulatory hormone is GnRH and its release must be pulsatile.

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9
Q

What substance inhibits FSH?

A

Inhibin.

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10
Q

What substance inhibits LH?

A

Progesterone and testosterone.

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11
Q

What four hormones all have a common alpha-subunit?

A

LH. FSH. TSH. hCG.

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12
Q

What does ACTH do? What is the upstream regulatory hormone?

A

Stimulates the adrenal cortex to produce and release hormones like cortisol. The upstream hormone is corticotropin releasing hormone (CRH). Cortisol itself is a negative feedback on the release of ACTH.

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13
Q

What does Melanin releasing hormone do?

A

MSH, it stimulates the release of melanin and involved in sexual arousal.

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14
Q

How is ACTH and MSH related?

A

ACTH is synthesized as part of a large precursor called proopiomelanocrotin (POMC), which also contains the sequence for other hormonal peptides, includiing the lipotropins, melanocyte-stimulating horomones (MSH) and beta-endorphins.

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15
Q

Why do we see skin hyperpigmentation in primary adrenal insufficiency?

A

In this disease, cortisol is low so the hypothalamus releases CRH, which in turn makes POMC, where ACTH is derived from; ACTH stimulates more cortisol. However, the POMC is also the precursor for MSH. Therefore, increased POMC leads to increased MSH as well, giving the hyperpigmentation.

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16
Q

What does TSH do? What is the upstream hormone regulator?

A

Makes Thyroid hormone production and secretion, T3, and T4. Regulated upstream by Thyroid releasing Hormone (TRH).

17
Q

What does GH do? What is the upstream hormone regulator?

A

It stimulates growth, decrease glucose uptake, increase protein synthesis and organ size and lean body mass. The upstream regulating hormone is Growth hormone releasing hormone (GHRH) and growth hormone inhibiting hormone (somatostatin).

18
Q

What is the downstream hormone for Growth hormone?

A

Insuli-like growth factor-1 (IGF-1).

19
Q

What conditions stimulate GH release?

A

Exercise. Sleep. Puberty. Hypoglycemia. Estrogen. Stress. Endogenous opiates.

20
Q

What conditions inhibit GH release?

A

IGF-1. Obesity. Pregnancy. Hyperglycemia.

21
Q

What does prolactin do? What upstream hormone regulates it?

A

Causes milk production and secretion. Inhibits ovulation by inhibiting GnRH. It is stimulated by TRH. It is inhibited by dopamine.

22
Q

What are the causes of hyperprolactinemia?

A

Pregnancy/nipple stimulation. Stress (physical/psychological). Prolactinoma (associated w/ bitemporal hemianopsia). Dopamine antagonists: antipsychotics (haloperidol, risperidione), domperidone, metoclopramide, methyldopa (Technically a dopa analogue that inhibits dopa decarboxylase).

23
Q

What would be the symptoms of hyperprolactinemia in a Male?

A

Hypogonadism (low test) which causes decreased libido, impotence, infertility (low sperm count), gynecomastia, rarely galactorrhea.

24
Q

What would be the symptoms of hyperprolactinemia in a premenopausal female?

A

Hypogonadism which leads to infertility, oligo/amenorrhea, rarely galactorrea.

25
Q

What would be the symptoms of hyperprolactinemia in a postmenopausal female?

A

None since already hypogonadal.

26
Q

Why does hyperprolactinemia causes hypogonadism?

A

Because it inhibits GnRH, which means low LH and FSH.

27
Q

Why can a prolactinoma cause bitemporal hemianopsia?

A

It can because of its location: the tumor can impinge on the optic chiasm.

28
Q

What is the treatment for prolactinoma?

A

Bromocriptine and Cabergoline. Surgical intervention.

29
Q

How do we diagnose acromegaly or gigantism?

A

Check IGF-1 because GH is released in a pulsatile manner. To confirm the high IGF-1, you do the oral glucose tolerance test and check the GH instead of the glucose (GH should go down unless it is a tumor, which GH will stay the same).

30
Q

What does somatostatin do?

A

In the CNS, PNS, and peripheral organs somatostatin decreases endocrine and exocrine secretion, reduces splanchnic blood flow, reduces gastrointestinal motility and gallbladder contraction, and inhibits secretion of most gastrointestinal hormones.

31
Q

When do we use somatostatin?

A

Pituitary excess: acromegaly, thyrotropinoma, ACTH-secreting tumors. GI endocrine excess: Zollinger-Ellison syndrome, carcinoid syndrome, VIPoma (AKA pancreatic cholera), glucagonoma, insulinoma. Certain diarrheal disease. Need to reduce splachnic circulation: portal hypertension (bleeding varices), bleeding peptic ulcers.

32
Q

What is Sheehan syndrome?

A

Occurs after the delivery of a baby if the mom had massive postpartum hemorrhage that caused underperfusion of the pituitary, which causes necrosis. this leads hypopituitarism. Causes agalactorrhea, amenorrhea, hypothyroidism, hyponatremia.

33
Q

A patient’s MRI revels replacement of tissue in the sella turcica w/ CSF. What is the most likely clinical presentation?

A

“Empty Sella” Usually enough residual pituitary cells to cause no symptoms, but can cause symptoms of pituitary hormone deficiency.

34
Q

What are 5 clinical symptoms of acromegaly?

A

Large hands and feet. Coarse facial features. Increased spacing of teeth. Deep voice. Impaired glucose tolerance or diabetes.

35
Q

RFF: Inability to breastfeed, amenorrhea, cold intolerance.

A

Sheehan syndrome.

36
Q

RFF: Infertility, galactorrhea, and bitemporal hemianopsia.

A

Prolactinoma.

DIT Endocrine (12 decks)

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